restrain healthcare costs, the U.S. system is pretty much what you would come up with. Not single payer so no rationing (which is needed because 30% of expenses are expended on people in the last six months of life) and no command and control cost-cutting. So you get neither the drawbacks (government control) nor the benefits (SOME cost-cutting, although not close to as good as market forces) of single payer.

But then you have widespread insurance with tons of mandates. That means most of the cost of care is not directly borne by the patient, so they don't know or care what it costs. Then you add the trifecta: insurance paid for largely by employers (or the government) so that most of the cost of insurance is ALSO not borne by the patient.

When you eliminate any easy-to-see tie between people's healthcare consumption, what their doctor charges, and what they have to pay, you get what we have. Which is . . . well it isn't good. Single payer might actually cost less at this point.